SMART Government Act Briefing for HCPF
COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES
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02:10 PM -- SMART Government Act Briefing for HCPF
Susan Birch, Executive Director, Health Care Policy and Financing Department (HCPF), provided a briefing on HCPF. She referenced a packet of materials for the committee (Attachment H). Director Birch noted that there are concerns with the health care system and the Colorado health system is undergoing great change and increase in health care costs.
Director Birch described statistics related to Medicaid caseloads and costs associated with different Medicaid populations. She gave statistics on health insurance coverage and Medicaid coverage in the state. Director Birch explained the mission of the Department, and described the goals of HCPF to improve health care access and outcomes for clients. She gave statistics on physical health outcomes, and noted that better outcomes lead to cost savings. She discussed the stewardship of financial resources of HCPF, and noted low administrative costs. She responded to questions on recoupment of funds used inappropriately.
Gretchen Hammer, HCPF's Medicaid Director, walked the committee through HCPF's performance plan. Ms. Hammer described the HCPF's strategic policy initiatives which includes delivery system innovation, tools of transformation, and operational excellence. Ms. Hammer explained the Accountable Care Collaborative (ACC) structure. In response to a question, Ms. Hammer clarified that savings is cost avoidance within the Medicaid program.
Josh Block, Budget Director, HCPF, explained how HCPF's budget setting process and forecasting for Medicaid works. He explained how the ACC savings are determined on a per client basis. He responded to further questions from the committee on the ACC savings. Director Birch noted that the savings are addressed in HCPF's budget.
In response to a question, Director Birch explained that the provider network for Medicaid has increased for the past four to five years, and that HCPF has a provider engagement unit to aid the process. Ms. Hammer explained that the capacity for ACC is large and has allowed Medicaid expansion. Members expressed concern about the increase in Medicaid caseload and available providers, especially with a provider rate cut. Ms. Hammer explained that the situation is being monitored closely and HCPF is required by law to procure data about client access to care. In response to a question, Ms. Hammer noted that there is a Medicaid customer service center that tracks provider issues, and HCPF can track client complaints from website use. Ms. Hammer responded to further questions about savings from the ACC.
The committee discussed the cost of Medicaid expansion in the state in the future. Director Birch and Mr. Block explained that the Medicaid expansion cost will increase from zero percent to a 10 percent state share by 2020 and how those costs will be paid for through the Hospital Provider Fee.
Director Birch talked about rural palliative care as part of the Medicaid program, in response to a question.
Ms. Hammer discussed the three major systems of medical care: behavioral health, physical health, and long term services and supports. Ms. Hammer discussed different payment reforms. Ms. Hammer talked about the community living program progress, and the use of waivers to provide cost effective services.
Tom Massey, Policy, Communications, and Administration Office Director, HCPF, explained the 2016 budget request and the factors that influence the request, including provider rate reductions, end of temporary increased primary care payments, and Hospital Provider Fee collections. Mr. Massey responded to questions about the end of increased primary care payments, and noted that the increase was always temporary in nature and the state can no longer afford the increased payments. Mr. Block noted that the decrease in primary care payments amounts to about 23 percent. Member expressed concern about the one percent provider rate reduction. Mr. Massey noted that the primary care providers do not experience the one percent rate reduction. He confirmed that specialist providers will experience the rate cut, and discussed creative ways for providers to cut costs. Mr. Massey explained that the hospitals will increase reserves in anticipation of the expansion. Mr. Massey noted that primary care offices are very important to the health care system and HCPF is open to suggestions for balancing the budget.
Mr. Massey continued by explaining the following three legislative proposals that focus on improving client experience while containing costs. He discussed non-emergency medical transport regulations, allowing health maintenance medication through the mail, and repealing obsolete reports.
Ms. Hammer gave two statutory required updates. She gave an update on HB 13-1196 to reduce waste through the ACC, and HB 14-1360, regarding in home support services.
In response to a question, Ms. Hammer noted that clients with disabilities or on waivers are required to be tracked, and very specific data is collected on these populations and their use of services. Ms. Hammer clarified that HCPF only has data on payments to providers.
Director Birch gave concluding remarks and ended the presentation.
Representative Primavera concluded the meeting.